We're going to be doing a neurological test for the lower body,
for space-occupying lesions of the lumbar spine.
And the slump test is a very good test for finding out, for adverse neural tension
or for a space-occupying lesion of the lumbar spine. It's one of my go-to tests
that I use in clinic
for neurological problems. If the person is showing sharp shooting pain, numbness, tingling in the leg,
in the foot, in the ankle, I usually recommend the slump test.
The straight leg raise works as well, but the slump test
does a pretty good job at finding out if there's a problem
neurologically in the lower body. So what I'm going to have Meghan do is put her hands behind her back,
just like that great,
and I want you to slump.
That's it, very easy.
You're very good at that. (Meghan giggles) That's great.
So slump down. I'm just going to have her flex her head down. I'm going to apply pressure
in this region
and on her head at the same time. Okay? >>Mhmm.
>>Now what I want you to do is I want you to,
you can do this actively, you can have her do it actively, or you can do it yourself but
for most people having the person actively do it is quite simple. So I want you to extend your leg.
Great.
Perfect, any sharp shooting pain down the leg at all? >>No.
>>Great.
Bring your toe towards your head. Good.
Now if there were positive signs with that
I'd have her, now look up at the ceiling,
that should diminish them.
And when she puts her head back down again
that should reproduce the pain. And just let your leg drop. Good.
We're going to do the straight leg raise, which is
someone similar to the slump test. It's for
a space-occupying lesion of the lumbar spine, a disc,
something encroaching in the foraminal space.
Yeah, it's very similar to the slump test,
though it's done in a supine position. So how we want to do this,
we want to bring
the leg up. I want to
adduct a-d-d,
medially rotate,
bring it up
and if she gets back pain, sharp shooting pain down the leg
from that I drop it down
and I dorsiflex. If that reproduced it it's highly probable there's something going on in the lumbar
spine.
The other thing I can do is I can have her, flex your neck
and I can dorsiflex at the same time. And you can see the similarities between
the slump test and the straight leg raise. Okay, thank you. So if there's a space-occupying lesion
it reproduces the pain
in through the leg, here,
I drop it down a little bit, dorsiflex, reproduces it.
Again, it's highly probable there's something going on
neurologically in the lumbar spine.
Okay so,
there's something called the well leg raise which you're testing the opposite leg first.
You're testing the leg opposite to the leg where the person's having the pain. So if Meghan was having pain down
this leg,
I would do the straight leg raise on the opposite side, it's called the well leg raise.
And if it reproduced pain down this side it usually indicates that the lesion is
a little larger than normal. It's a fairly large lesion that's causing the nerve root.
So it's exactly the same as
the straight leg raise, but done on the opposite side. So bring the leg up,
medially rotate
and
yes, abduct and medially rotate, bring it up.
And if she had pain down this leg,
that means it's highly probable it's a space-occupying lesion and may be fairly large.
The modified way of doing the straight leg raise is from a side-lying position.
Again, remember what we're trying to do is, if there's a space-occupying lesion of the lumbar spine
such as a disc,
it's putting pressure on a nerve, we're stretching the nerve, we're stretching the sciatic nerve,
and when you tug on a nerve that's inflamed and
irritated it usually responds negatively, which will help to confirm, that's why we use special
tests, to help to confirm,
to find out if there's tissue that's being affected.
So we have to stress it or pull on it
or do some securing forces
to identify the
tissue problems.
So the
modified version of a straight leg raise
is from a side-lying position.
I bring the leg up. I abduct and medially rotate. Bring it up. If there's pain I drop it down a little bit,
recreation of pain down the leg,
and do dorsiflexion. If that increases pain again it would be positive for a
space-occupying lesion of the lumbar spine.
Let me do valsalva which increases intrathecal pressure.
And the simple way of doing it is ask your client to
take their thumb, put their lips against their thumb and blow like they're blowing up a balloon,
increases pressure in through here which will apply
increased pressure on the disc. And if there is a disc that's
prolapsed a bit,
it'll put more pressure on the nerve,
which will recreate more symptoms down the leg.
So take your right thumb.
Give it a blow. Good.
Great. So it increases pressure in through here,
which increases the pressure on the disc and the nerve
and pain.
This is a Farfan
test. It's a general test to
test in
the facet joints, the lumbar spine,
the joint capsules, the supraspinous ligament and interspinous ligament.
So you place your hand over T12. I'll just find T12 here.
And your other hand on the ASIS.
And it's a rotational movement.
So I'm applying pressure, a little bit of pressure down, as I'm doing this.
And you can rotate and move your hand down
along the spinous processes
to test the
joint capsule,
facets,
supraspinous and interspinous ligaments of the lumbar spine.
So it's a not very specific test.
If you found something positive with this than you would try and narrow down with other tests
to find out what tissue is causing the problem.
We're going to show a Pheasant's test, which
it's testing for instability of the lumbar spine.
You can use joint play. Joint play is pretty good for testing for the instability of the lumbar spine. this is a quick simple test
to find out if there's
discomfort in
S1, L5, L4
or if pain goes down the
legs as you
bring
the heels to the buttocks.
So just putting your hand over the L4, L5,
doing compression,
the heels to the buttocks.
And if there's pain
produced in through here,
there could be some instability of the lumbar vertebra
and or pain down the legs when you
apply pressure
up like this.
This could be related to
weakness of some of the lower cross muscles.
We're going to test the facet joints of the lumbar spine.
The quadrant test challenges the facets and it does diminish the foraminal space to
some degree of the lumbar spine.
So what I want her to do. There's a couple different ways of doing it.
What I'd like you to do
is I would like you to rotate your shoulders this way.
I'm going to put your hand back here and I want you to reach back and touch the back of your leg.
Okay so that's a rotation and extension at the same time. And come up.
And the other way I can do it
is I can have you
cross your hands in front of you.
I can
have her extend back,
rotate.
And I'm going to apply pressure like this.
That's another way of doing it.
So rotate, sorry,
extend back
and I'm going to rotate you the other way.
I'm going to take this way
and apply pressure
in a direction downward.
That puts pressure on the facet joints
and the intervertebral space,
challenging the facet joints. If there's facet joint irritation or discomfort
it would certainly show with this test.